More children being diagnosed with precocious puberty in Singapore!

Paediatricians say that they are seeing more children with symptoms of precocious puberty in Singapore. Why is it happening?

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Puberty is when kids develop physically and emotionally into young men and women. On an average, it starts between ages 8 and 13 in girls, and between ages 9 and 14 in boys.

Puberty that begins before age 8 in girls and before age 9 in boys is considered precocious puberty or early puberty. According to The Straits Times, paediatricians are reportedly seeing more children with precocious puberty in Singapore.

Precocious puberty in Singapore

Apparently, the National University Hospital (NUH), saw 22 children with precocious puberty last year, up from just 7 in 2009. So, how can parents spot precocious puberty?

Following are some signs of precocious puberty:

In girls (when these signs show before 7 or 8 years of age):

breast development

pubic or underarm hair development

rapid height growth — a growth "spurt"

start of vaginal bleeding or menstruation (her period)

acne

"mature" body odour

In boys (if these signs are present before 9 years of age):

enlargement of the testicles or penis

pubic, underarm, or facial hair development

rapid height growth — a growth "spurt"

voice deepening

acne

"mature" body odour

Types of precocious puberty

The two main types of precocious puberty are central precocious puberty and peripheral precocious puberty.

Central precocious puberty, or "normal early puberty": This is the more common type of early puberty.

Dr Cindy Ho, consultant at NUH's division of paediatric endocrinology has been quoted by The Straits Times as saying, "In central precocious puberty, the whole sequence kicks in because the switch for puberty in the brain gets switched on earlier."

Peripheral precocious puberty: In this, the hormones oestrogen and testosterone trigger the symptoms. But the brain and pituitary gland are not involved. It's usually a local problem with the ovaries, testicles, adrenal gland, or a severely under active thyroid gland.

Possible causes of precocious puberty

A number of factors seem to be related to precocious puberty. These include:

Childhood obesity

There seems to be a link between childhood obesity and early puberty. Dr Alison Snodgrass, a consultant at KK Women's and Children's Hospital's (KKH) tells The Straits Times, "There may be a family history of early puberty. Girls who are obese also tend to go into puberty earlier."

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Diet

Higher total protein, animal protein, meat intake, and consumption of processed foods in children age 3-7 have been associated with earlier menarche in multiple studies. In contrast, higher vegetable protein intake at age 5-6 is associated with later menarche. Vegetarians have also been observed to have a later onset of menarche, compared to non-vegetarians.

Being exposed to sex hormones

Coming in contact with an oestrogen or testosterone cream or ointment, or other substances that contain these hormones (such as an adult's medication or dietary supplements), can increase your child's risk of developing precocious puberty.

Prenatal factors

Studies have found that mothers who were overweight before pregnancy and developed gestational diabetes when pregnant gave birth to daughters who started puberty earlier.

Stress

Other studies have found that toxic stress may also play a role in precocious puberty in girls. According to paediatric endocrinologist Louise Greenspan, “Girls who grow up in families with a lot of strife or violence in their neighbourhood are more likely to develop earlier.” Her research found that girls who grew up without a biological father are twice as likely to get their period before age 12.

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Impact of precocious puberty on the child

For kids, early puberty can cause physical and emotional problems. They include:

Short stature

While kids with precocious puberty are often tall for their age, some end up short as adults. This is because, once puberty is over, growth stops or slows down considerably.

Since precocious puberty ends earlier than normal puberty, these kids stop growing at an earlier age - and sometimes, the end result may be a shorter height than they would have otherwise had.

Worry of sexual abuse

The changes in the child's body may make her vulnerable to sexual abuse. Although there is not enough evidence to support it, there also seems to be a tendency for earlier engagement in sexual behaviour.

Stress and behaviour problems

Puberty can be a confusing time. Dr. Ho tells The Straits Times, "Children may not know how to handle mood swings and take care of their personal hygiene. These things might be scary to them."

It can be all the more stressful for younger kids with early puberty. They might feel awkward or self conscious about their bodies, and looking different from their peers.

What to do if you suspect precocious puberty:

There is little that parents can do to prevent early puberty, but in the event of it happening, they should not ignore the symptoms, and should seek treatment for their child.

Dr Christelle Tan, a paediatric medicine specialist and consultant at Raffles Specialists' Holland Village centre, tells The Straits Times, "Children with early puberty should see a paediatrician to determine if the puberty is a normal or variant type."

The doctor will assess the child, and treatment will usually depend on how early the onset of puberty is.

According to Dr. Ho, treatment involves hormone injections to block the puberty, which usually have to be administered once a month or every 3 months. A monthly injection costs more than $200, depending on the level of subsidy. The injections can be stopped once the child reaches the normal age of physical maturity.